We set up our patients on a breast board as well. We were originally seeing a lot of pitch variance in our port films prior to having Vision RT. One of the things that drastically helped or assisted in fixing the pitch was getting new breast boards/tightening the brackets on the existing ones.
During simulation prior to scanning or having the physician come in we have the patient bring their arms up into the treatment position. We have them try to relax into the table. We then call the physician in, this gives the patient enough time to focus on just letting themselves sink into the table. Once patient’s borders are marked we have the patient bring their arms down and wiggle a bit and then bring arms back up.
From sim we are given a nipple line/ML number which coincides with where the laser falls on the side ruler of the breast board (verifying that both sides of the board are marked the same). This helps with sup/inf positioning of the patient which assists with pitch as mentioned by Ellen. Something else to consider is when using Align RT we have found that adjusting the patients rotation and roll to be as close to zero, helps with getting less of a pitch. We do rotation and roll first, then translations and if pitch is still not within tolerance we adjust patient up or down on the board.
Sorry for the lengthy reply. Hope this helps. 🙂